Risk-based Auditing Solutions Help Avoid Drug Testing Noncompliance

Medical coding for drug testing is complex, and improper coding can result in substantial fines. Doctors and healthcare organizations can help protect themselves with risk-based auditing software solutions.

has seen considerable growth in the number of audits for drug test billing noncompliance. Rules and regulations governing medical coding and billing for drug testing change annually, and many healthcare providers struggle to keep up with the most current guidelines. The result can be hefty fines—often in the millions of dollars—for physicians, drug testing laboratories and hospitals. The solution, says healthcare support and management industry leader Fi-Med Management, is to implement risk-based auditing software solutions such as REVEAL/md to track and identify noncompliant healthcare providers before audits ever take place.

Healthcare providers use drug testing as a way to identify drug use and abuse, and to monitor patient compliance with treatment programs.(1) However, medical coding and billing for drug testing are complex, and it's easy for healthcare providers to become noncompliant, even if unintentionally. Unfortunately for these providers, noncompliance with regulations surrounding billing for drug testing substantially increases their risk of audits and fines from insurance companies and governmental agencies like Medicare.

The healthcare industry has already seen millions of dollars in fines levied against individual providers, hospital systems and drug testing laboratories as a result of noncompliance with rules for urine drug testing billing.(2,3) Even if a healthcare provider unintentionally overbills for drug testing services, governmental agencies and insurance companies still view this action as fraud, since it can result in substantial overpayments to these providers.

Adrian Velasquez, president, CEO and co-founder of Fi-Med Management, says, "The rules surrounding how providers and healthcare systems bill for drug testing are complicated, and it's easy to overbill. Even if the overbilling is accidental, the liability to an individual or healthcare organization is greatly increased—the insurance industry views overbilling as a type of fraud, and many organizations have already been sued for millions of dollars. One of the best ways that providers and healthcare institutions can protect themselves is by incorporating risk-based auditing software into their electronic health records systems to help identify compliance issues before audits can occur."

Risk-based auditing software such as REVEAL/md analyzes billing and coding and identifies healthcare providers who pose compliance risks before audits take place. Implementing these types of solutions helps to reduce liability for individual providers and healthcare systems by identifying opportunities for retraining early—before a visit from auditors.

Velasquez says, "Early identification of providers who aren't billing correctly is key to avoiding audits and fines. The sooner a healthcare organization can identity providers who are noncompliant with drug testing coding requirements, the sooner those providers can receive further training on correct coding and billing practices. Healthcare practices both large and small can help reduce their risk by taking steps to identify problems preventing compliance with drug testing coding rules before an audit ever takes place."

About Fi-Med:

Since 1993, Fi-Med has been working alongside healthcare providers and networks to maximize revenue and reduce risk, from catching billing errors to providing high-level safeguards against compliance risk. Fi-Med is a healthcare technology leader helping to disrupt the status quo of the ever-increasing burden of government compliance for hospitals and hospital systems nationwide, by providing effective financial management and reporting services. Its strong reputation for maximizing revenue and reducing risk for hundreds of hospitals, labs, private physicians and healthcare networks is the direct result of its technology tools.

REVEAL/md is Fi-Med's keystone product, empowering healthcare provider compliance departments with the ability to engage in proactive management of physician part B audits of documentation and coding. For more information, visit www.fimed.com.

About Adrian Velasquez:

With a history of extraordinary successes in the healthcare field, Adrian E. Velasquez partnered with Christine Krause to form Fi-Med Management, Inc., in 1993. Their mission: to bring business acumen and compliance expertise to healthcare providers throughout the United States. They've become trusted experts in the fields of financial healthcare management, compliance and risk assessment, and chronic care management. Adrian's extensive experience as a system administrator and national healthcare consultant formed the foundation that he harnesses today for Fi-Med clients.

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